Pediatric extubation readiness tests should not use pressure support

Robinder G. Khemani; Justin Hotz; Rica Morzov; Rutger C. Flink; Asvari Kamerkar; Marie LaFortune; Gerrard F. Rafferty; Patrick A. Ross; Christopher J L Newth

doi:10.1007/s00134-016-4387-3

Pediatric extubation readiness tests should not use pressure support

Robinder G. Khemani^*, Justin Hotz, Rica Morzov, Rutger C. Flink, Asvari Kamerkar, Marie LaFortune, Gerrard F. Rafferty, Patrick A. Ross, Christopher J L Newth

^*Corresponding author for this work

King's College London

Research output: Contribution to journal › Article › peer-review

75 Citations (Scopus)

417 Downloads (Pure)

Abstract

Purpose: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH₂O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Methods: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH₂O, CPAP 5 cmH₂O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. Results: We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p

Original language	English
Pages (from-to)	1214-1222
Number of pages	9
Journal	Intensive Care Medicine
Volume	42
Issue number	8
Early online date	18 Jun 2016
DOIs	https://doi.org/10.1007/s00134-016-4387-3
Publication status	Published - 1 Aug 2016

Keywords

Airway extubation
Pediatrics
Ventilator weaning
Work of breathing

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10.1007/s00134-016-4387-3

Pediatric extubation readiness_KHEMANI_Firstonline18June2016_GREEN AAMAccepted author manuscript, 532 KBLicence: Unspecified

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title = "Pediatric extubation readiness tests should not use pressure support",

abstract = "Purpose: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Methods: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. Results: We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p ",

keywords = "Airway extubation, Pediatrics, Ventilator weaning, Work of breathing",

author = "Khemani, {Robinder G.} and Justin Hotz and Rica Morzov and Flink, {Rutger C.} and Asvari Kamerkar and Marie LaFortune and Rafferty, {Gerrard F.} and Ross, {Patrick A.} and Newth, {Christopher J L}",

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AU - Khemani, Robinder G.

AU - Hotz, Justin

AU - Morzov, Rica

AU - Flink, Rutger C.

AU - Kamerkar, Asvari

AU - LaFortune, Marie

AU - Rafferty, Gerrard F.

AU - Ross, Patrick A.

AU - Newth, Christopher J L

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Y1 - 2016/8/1

N2 - Purpose: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Methods: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. Results: We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p

AB - Purpose: Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH2O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support. Methods: Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH2O, CPAP 5 cmH2O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support. Results: We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p

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Pediatric extubation readiness tests should not use pressure support

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